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CPS Exam #1 > Case #3 > Flashcards

Case #3 Flashcards

1
Q

What is Lansoprozole for?

A

Stomach Ulcers

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2
Q

Hymenoptra =

A

Type of Bee

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3
Q

Icterus =

A

Jaundice

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4
Q

BUN =

A

Blood Urea Nitrogen

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5
Q

Atalectesis =

A

Complete or partial lung collapse

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6
Q

Calcified lymph nodes indicate –

A

Previous histoplasmosis

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7
Q

Pivotal Abdominal Exam Features to Note

A

Location
Character
Acuity
Duration

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8
Q

Symptoms associates with Abdomen

A

Nausea, Vomiting, Stool changes,

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9
Q

______ and _______ histories in women are important.

A

Sexual. Menstrual

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10
Q

In abdomen, inspect for _______. Auscultate for _____.

A

Distention. Bowel Sounds.

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11
Q

Distention may indicate…

A

Bowel obstruction

Ascites

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12
Q

No Bowel Sounds =

A

Intra-abdominal catastrophe

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13
Q

High-pitched tinkling sounds and rushes

A

Intestinal Obstruction

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14
Q

What is the last part of the abdominal exam you should do?

A

Palpation of the painful area.

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15
Q

Perineal exams for an abdominal problem?

A

Rectal
Pelvic
Testicular

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16
Q

Pathology of GallBladder DIsease.

A

Bile gets concentrated and thickened from inc. cholesterol or lack of bile.
Gallstones formed from the sludge from cho. and bile

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17
Q

Classy word for gall stone formation?

A

Choleithiasis

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18
Q

What occurs in acute choleithiasis?

A

Stone obstructs the cystic duct

Inflammation

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19
Q

What is a choledocholithiasis?

A

A calculi in the common bile duct

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20
Q

Ascending cholangitis?

A

Inflammation of the bile duct

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21
Q

Risk Factors for Gallstones? (6)

A 
Age
Women
Obesity
Fast Weight Loss
Pregnancy
Crohn's
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22
Q

Race most likely to get gallstones…

A

Native Americans

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23
Q

The Five F’s of Gallbladder Disease

A

Fair, Fat, Over 40, Fertile, Female

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24
Q

With epigastric pain…first thought with…
Short episodes, no jaundice
Persistant Pain, Bili. Normal
Persistent Pain, Increased Billi.

A

Billiary Colic
Cholecystitis
Choledocolithiasis or Pancreatitis

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25
Q

Describe basic normal bilirubin processing.

A

RBC breakdown –> Unconjugated Bili –> Into Hepatocyte/Conjugation –> Conjugated Bili into Bile –> Excretion

26
Q

With hepatocyte damage…what happens to bilirubin processing?

A

….–> Into hepatocyte –> some conjugated, some remains unconjugated –> both largely released back into blood

27
Q

Dark urine indicates…

A

Bilirubin in the Urine

CBD Obstruction or Hepatitis

28
Q

Difference seen in patients with CBD vs cystic duct obstruction?

A

In cystic obstruction, CBD is open, so no hyperbilirubinemia, dark urine, or ALT/AST

29
Q

What does a fever with obstruction suggest?

A

Bacterial colonization

30
Q

What are Rigors? What do they Suggest?

A

Visible Shaking/Teeth Chattering Chills

Bacteremia

31
Q

____% of adults have asymptomatic gallstones

A

10

32
Q

Gallbladder gangrene is…

A

Gallbladder wall with necrotic and denuded mucosa

33
Q

What should you see in a patient with acute cholecystitis?

A

Thickened gallbladder wall

34
Q

How do you distinguish between a gallbladder polyp and a gallstone on ultrasound?

A

No Shadow = Polyps

35
Q

T or F. Gall Bladder polyps are typically cancerous.

A

False
Usually found incidently
They do have malignant potential

36
Q

What are polyps typically a reflection of?

A

Cholesterolosis – lipid deposits

37
Q

How do you treat >1cm gallbladder polyps?

A

Cholecystectomy

38
Q

HIDA scan can be used to assess….

A

Function of Gallbladder

Measures filling of the gallbladder – if blocked, nothing in

39
Q

What is MCRP?

A

Magnetic resonance cholangiopancreatography

Eval common duct with mild dilations

40
Q

What is ERCP?

A

Endoscopic retrograde cholangiopancreatography

If patient his dilated CBD< stones, jaundice

41
Q

Describe Biliary Colic presentation

A

Intense, constant dull discomfort in RUQ
Assoc. w/ diaphoresis, nausea, and vomiting
No relieved by flatus, BM, squatting
Not worse with movement

42
Q

What is biliary colic anyway?

A

Gallbladder contracts, forces a stone/sludge against the GB outlet
Increased GB pressure causes pain, relaxation causes the presure to drop
- Commonly seen after fatty meals

43
Q

Cause of ascending cholangitis?

A

Infection from organisms ascending from duodenum

44
Q

What is Charcot’s Triad?

A

Fever, Abdominal Pain, Jaundice

45
Q

What is Reynold’s Pentad?

A

Fever, Abdominal Pain, Jaundice, Confusion, Hypotension

46
Q

What is acute cholecystitis?

A

Prolonged RUQ/epigastric pain (over 4 hours)

Assoc. with fever/leukocytosis

47
Q

How to distinguish Biliary Colic, uncomplicated gallstone, and acute chole.?

A

Pain over 4 hours – Acute Chole.
Poorly localized, Negative Murphy Sign – Uncomp. gallstone
HIDA to distingush Biliary and acute chole.

48
Q

What is Murphy’s Sign?

A

Hypersensitivity to deep palpation of subcostal area with deep breath

+ is patient discomfort and insp. arrest

49
Q

What is sonographic murphy’s sign?

A

Murphy’s from before, but using ultrasound to confirm what you’re pushing on

50
Q

Untreated cholecystitis?

A

Gangrene
Perforation
Fistula
Infection

51
Q

Bacteria most likely to get GB?

A

E Coli

52
Q

Most common type of major surgery in US?

A

Laparoscopic Cholecystectomy

53
Q

Complications of Laparo. Cholecyst.?

A

Bile Duct Injury
Bile Leaks
Bleeding
Bowel Injury

54
Q

Two biggest commonalities in lap. chole. complications.

A

Patient Selection

Surgical Experience

55
Q

Cholecystitis medical therapy?

A

Ursodeoxycholic acid

56
Q

What does Ursodeoxycholic Acid (Ursodiol) do?

A

Taken orally to break down cholesterol stones over 1-2 years.

Can only work on small stones in a functional GB.

57
Q

Other diseases associated with GB probs?

A

CV disease and Diabetes

58
Q

Best approach for gallbladder disease?

A

Prevention

59
Q

Protective Factors for GB?

A 
Statins
Ascorbic Acid
Lecithin
Taurine
Coffee
Omega-3s
60
Q

How is atelectasis often imaged?

A

Xray

61
Q

What is histoplasmosis?

A

Infection from fungus spores in MW soil

Typically asymptomatic

62
Q

Why is it important to confirm histoplas.?

A

Looks very similar to sarcoidosis.

Treatment swith immunosuppressives could be bad

CPS Exam #1 (4 decks)

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